This is an application for a K08 award for Dr. Martin Were, a Research Scientist in medical informatics at Regenstrief Institute, Inc. and an Assistant Professor of Medicine at Indiana University School of Medicine. Dr. Were is establishing himself as a health services researcher with the long-term goal becoming an independent physician investigator focusing on implementing and evaluating health information technology (IT) interventions aimed at improving quality of care and patient safety. This K08 award will provide Dr. Were with the support necessary to accomplish the following career development goals: (1) gain knowledge in developing and implementing IT solutions to address daily challenges in patient-care; (2) enhance expertise in biostatistics, study design, implementation research, and on critical evaluation of health IT interventions; and (3) establish the foundation for an R01 application. Dr. Were will achieve these goals with the continued oversight of an internationally-recognized advisory panel of medical informaticians and health services researchers from Regenstrief Institute and Harvard Medical School. The research objective of this K08 grant application is to implement and evaluate two health-IT interventions aimed at improving management of tests with pending results at hospital discharge. Studies show that nearly half of patients discharged from the hospital with pending test results experience medical errors related to missed tests. These errors are largely due to poor communication of pending tests to the follow-up provider, and suboptimal methods for managing test results. Dr. Were's research will focus on IT-based interventions to improve both documentation of pending tests into discharge summaries, and appropriate and timely delivery of returning results to the designated follow-up provider. The specific aims of this proposal are outlined below: Aim 1-develop and implement a tool to automatically identify tests with pending results at hospital discharge and assist in incorporating these tests into the discharge summary; Aim 2- evaluate the impact of this tool on accuracy of documenting pending tests in discharge summaries; Aim 3- modify an existing clinical-messaging tool in order to automatically deliver results for pending tests to the follow-up providers; and Aim 4- evaluate the impact of the modified messaging tool on providers' actions and attitudes. This career award will provide Dr. Were with the experience and skills he needs to transition into an independent researcher. In addition, work done during the award period will form the basis for a large randomized trial to evaluate the impact of the two health-IT interventions on diagnostic errors and on patient outcomes. 7. Project Narrative Poor follow-up of tests whose results are not back at the time of hospital discharge leads to many medical errors. In this project, we create, implement, and evaluate two health information technology interventions aimed at improving communication and follow-up of these tests. Through these interventions, we hope to reduce medical errors and improve safety for patients discharged from the hospital with pending results.